Provider Demographics
NPI:1548222763
Name:GEHRED, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:GEHRED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11014 ASH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-3732
Mailing Address - Country:US
Mailing Address - Phone:303-255-1246
Mailing Address - Fax:303-255-1246
Practice Address - Street 1:11014 ASH PL
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-3732
Practice Address - Country:US
Practice Address - Phone:303-255-1246
Practice Address - Fax:303-255-1246
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCE5708Medicare ID - Type UnspecifiedCOLORADO FAMILY MEDICINE
COG57702Medicare UPIN